If you are living overseas, please indicate your current country of residence.

Phone Number ###-###-####

Gender

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When were you born? (MM/DD/YYYY)

To comply with legal requirements, we must ask for your birthdate.

School Information

School Name

High School Graduation Year

Please enter a 4-digit year (example: 2015)

Grade Point Average (on a 4.0 scale)

School City

School State

School Type

Public

Private

Parochial

Charter

Alternative

Homeschool

Online

Other

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number ###-###-####

Parent/Guardian Email Address

Referring Teacher Information

Please include the contact information for a social studies teacher (history, government, civics, economics, etc.). We may contact this teacher to provide a reference for you.

Teacher First and Last Name

Teacher Phone Number ###-###-####

Teacher Email Address

Page 2

More Information About You

What sources do you use to get news? (You may select multiple options)

CNN

FOX News

MSNBC

CBS

NBC

ABC

Wall Street Journal

The Economist

Yahoo

Google

Huffington Post

Drudge Report

The Daily Show

New York Times

Local Newspaper

Other

If you chose "other" under news sources, please explain:

Which (if any) of the following groups or activities have you been involved in since you started high school? (You may select multiple options)

Athletics

Boy/Girl Scouts

Boys/Girls State

DECA

FBLA

HOBY Youth Leadership

Interact Club

Key Club

Mock Trail

Model United Nations

National Honor Society

ROTC

School Government

School Newspaper

School Yearbook

Speech/Debate

We The People

YMCA Youth and Government

Other

None

If you chose "other" or "Athletics" under groups and activities, please explain:

In which (if any) of these groups have you held a leadership position? (You may select multiple options)

Athletics

Boy/Girl Scouts

Boys/Girls State

DECA

FBLA

HOBY Youth Leadership

Interact Club

Key Club

Mock Trial

Model United Nations

National Honor Society

ROTC

School Government

School Newspaper

School Yearbook

Speech/Debate

We the People

YMCA Youth and Government

Other

None

Please explain the extent of your leadership positions chosen:

Have you taken Advanced Placement (AP) or Dual-Credit courses in any of the following? (You may select multiple options)

U.S. History

World History

U.S. Government and Politics

Comparative Government and Politics

Microeconomics

Macroeconomics

Philosophy

Other

IB Program

How did you hear about Constitutional Academy?

If you searched the internet, which search engine did you use?

If you were referred by an another organization, which organization told you about the Bill of Rights Institute?

Page 3

Essay Questions

Please answer the following questions. We recommend that you type your responses in another program and then copy and paste each essay in the appropriate text box so that the page does not time out.

In 200 words or less, explain why you want to participate in the 2017 Constitutional Academy and how will being a participant will affect your career goals?

In 200 words or less, please give an example of a time where you exhibited leadership skills in your school or community on a specific project or in a specific situation. Please explain your role, the outcome/result and what lessons you learned.

In 200 words or less, please describe one political issue that you are passionate about. Why are you passionate about it? Why should that issue be a primary concern for legislators? In your opinion, what avenues could be taken to address the issue?

Tell us when you want to hear from us

Knowledge is power. Our student newsletters feature internships, jobs, scholarship opportunities, social media contests, current events, and other exciting student focused opportunities that you won't want to miss! Should we sign you up?.

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PARTICIPANT PUBLICITY RELEASE

I, the undersigned, in consideration of possible publicity and other valuable consideration, receipt of which is hereby acknowledged, hereby authorize The Bill of Rights Institute and its affiliates, designees, assignees, transferees, licensees, grantees and any entities or persons acting on behalf of any of the foregoing (collectively, “Grantees”) to film, photograph and otherwise record my likeness, voice and any other form of my identity, and grant Grantees the right to create, reproduce, alter, modify, publish, display, sell, transfer, exhibit and use my voice, likeness, and any other form of my identity in any manner (including without limitation advertising, promotion, and merchandising) or form, including without limitation all video, audio, digital, and print formats and any other media now known or hereafter created, including without limitation use via computer, the Internet, films, DVDs, video tapes, audio tapes, digital audio files, digital image files, photographs, prints, copies, facsimiles and electronically captured images thereof, without limitation as to method of reproduction or exhibit and without any territorial or time restrictions.Further, I hereby relinquish, give, transfer, and assign to Grantees all right, title, copyright and interest I may have in the finished product contemplated by this Release, agree that any and all materials created by or on behalf of Grantees are the property of Grantees, and I waive any right of review or inspection. I agree that no other material needs to be submitted to me for any further approval, and Grantees shall be without liability to me or any person for any distortion or illusionary effect resulting from the publication or dissemination of any likeness, audio recording, or other indicia of my identity. I state further that: (a) I am of legal age and capacity; (b) I acknowledge that nothing herein requires Grantee(s) to use my likeness as described herein or elsewhere; (c) I acknowledge that no compensation or consideration will be provided to me for the rights and releases granted herein, other than the potential publicity; (d) I have read, or have had read to me, this Release and have had the opportunity to ask questions before its execution, and I am fully familiar with and understand its contents; and (e) I hereby irrevocably release Grantees from any and all liability based upon, arising out of or in any way related to this Release or the exercise of the rights granted herein.

I have read this statement and agree to it

Acceptances are made on a rolling basis, with the final acceptances made by June 1st, 2018.

Thank you for your application, we look forward to reviewing your application!